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Uneven aging: The Brickendens light a path

Photo: The Globe & Mail

Sometimes an obituary grabs your heart. The Brickendens, Shirley and George, were such persons. Remarkable from their first meeting to their joint and chosen medically-assisted death, they illuminate a path some of us are just beginning to discern.

An interview given less than a week before they died, in which they explain their decision, is here.
The couple was a classic case of uneven aging in advanced old age: Shirley, 94, obtained approval for assisted death over a year ago, but for one of the two doctors required to approve the procedure, George did not meet the criteria. Then, at 95, he caught up.

After nearly 73 years together, they "flew away", as they always put it, holding hands in their own bed.

Their way is not for everyone, but it resonates for me because I saw, during the years when I worked in two large hospitals, that when a patient was in an advanced state of irreversible decline, unbearable suffering ennobled no one.

I am beginning to witness the end of life more frequently, among my own friends and family. Some endings are graceful, some are fraught. One day, I would like to be able to make certain decisions, difficult though they may be, and want my wishes to be compassionately respected. My beliefs allow the possibility of euthanasia, so I am watching as Quebec carefully tests this newly-acquired right. Over three hundred persons were approved for the option in 2017.

The Brickendens left after loving farewells and good champagne. I am grateful to them for publicly describing their poignant, entirely informed, and now legal act.

I read the article in The Globe -- very moving and really worth thinking about, although it pertains to particular circumstances. It would require both partners of a couple living to a similar state of readiness for death, able to be honest and open with each other, to feel reasonably clear of an uneven balance of decision-making. I can imagine dissension in some families--some of my siblings were less ready than others to let my mother go (not that her death was assisted but that some wanted to push harder for her to eat, for example. In my husband's family, there was a similar push for his mother to undergo a surgery she thought was pointless at that stage (we supported her decision, thus deepening a family rift that is unlikely to heal now. . . It would be easier to stand firm as a couple, I suspect.

materfamilias: Yes, circumstances have a great deal to do with the ability to enact this choice. Apparently the Brickendens had spoken of this wish to one another, and then to their children, for years before the possibility arose. In the case of dissention among children regarding treatment of a very ill parent, does BC have a registry like Quebec’s for advanced care directives? That precludes someone else making decisions, and dissention. By use either of an online form, or by having the witnessed form attached to her medical records, a parent can direct many specifics regarding interventions and types of palliative care. (She may also change these easily, as long as she is competent.)

If the presence of such directives and their content is shared family while the parent is well, that would, I hope, head off some of the fights I too have seen. The very worst time to address all this is when the parent is critically ill.

I realize the government have not initiated such measures purely in the name of a good death. Treatments with poor prognoses are costly, and a strain on limited resources. And some doctors are themselves biased toward prolonged, invasive treatment when there is no reason for it.

I told my husband if something horrible happened to me please don't let me suffer any more than we would let our little dog suffer in pain or a helpless miserable condition that has no chance of recovery.

I also believe that if someone is suffering from an incurable disease, and that person wishes to choose suicide, that should be allowed.

As I wrote this, I was keenly aware that some readers' religious or personal beliefs would not be consistent with such an approach.

Short of the Brickenden's act, there are palliative treatments that do not end life, but certainly nudge the process along. This has long been a strategy some persons who would neither want to be a recipient or provider of assisted suicide can accept. One of my friend's mothers had a form of sedation, combined with cessation of nourishment. To me there is little difference- it just took a week instead of a few minutes- but the family was on board with it.

I once asked my father, a doctor, what he thought. He said, "I have no problem with it being done in late stages when the patient is suffering, but let the family administer the drugs; don't ask us to do it." A friend's father was dying at home; he asked for someone to help him end an ordeal that had gone on for months. The care team left his daughter with medication and instructions.

Some doctors are very willing to administer end of life medication; they feel as Susie with the cute little black dog and I with my small black cat do - why should human friends and family members have less right to a painless (as possible) and calm exit?

Of course some have religious beliefs that forbid this, but this is no longer as much of a factor as it was decades ago, at least not here.

lagatta: I sure hope they are around if we choose that act. Two years ago I was redoing my will and the notaty refused to append a statement specifying my wishes re end of life care, because he was so against it...and he said, so was his daughter, an MD. I reminded him of the then new legislation, and made sure my wishes were explicit. I am also going the Registry route.

Several readers have contacted me via email to say they could not do it because of religious beliefs.

A majority of us are in favor of medical aid in dying. We want that option if it comes to that. If a person's religious belief would prevent that, they can certainly refrain from choosing to go that route. But please, don't take that choice away from others who don't share your belief.

Yes, I was talking about notaries' and doctors' religious beliefs, not those of individuals in terms of their own lives. It doesn't bother me in the least if people don't feel the right to end their own lives, just so they don't force me to live as a vegetable or in horrible pain.

Duchesse, thank you for this. It is beautiful. I so agree with the sentiment, "If one's religious belief prevents that, they can choose to refrain. But please, don't take that choice away from others who believe differently." Losing my agency would be the worst; I want that choice, always. And as you say, it is best communicated early and often.

royleen and lagatta: The ability to undertake such an act or to participate in helping someone (without being charged for a crime), is conferred by legal right. And we all know that laws can be repealed- as we have seen with women's reproductive rights.

"Please don't take that choice away" sounds like a request. When it comes to constitutional rights, those who want this right need to take action in their jurisdiction and, if it is already granted, make sure it stays.

Oh, I've taken lots of action in support of women's reproductive rights. Also for equality for LGBT people, though I'm not gay. One of my oldest friends is a gay man, and I have another close friend who is a lesbian. And know many others.

Agree that we must make sure that right stays! My phrasing wasn’t meant as a request! Thank you for the clarification. I am working harder than ever, for I was one of those who was sure Hillary would win... lesson learned!